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Health-care ‘system’ broken, requires fixing

May 27, 2011 Leave a comment

It’s time for the U.S. health-care ‘system’ to “become better and cheaper for everyone — to get cheaper by getting better,” declares columnist-futurist Joe Flower. I agree 100%.

We’re not talking “bending the cost curve,” cutting a few points off the inflation chart. We’re not talking a little cheaper, a little less per capita, a few percentage points off the cut of GDP that health care sucks up. We’re talking way cheaper. Half the cost. You know, like in normal countries.

We’re not talking a little better—skipping a few unnecessary tests, cutting the percentage of surgical infections a few points. No. Don’t even think about it. We’re talking way better. Save the children, help the people who should know better, nobody dies before their time, no unnecessary suffering. Seriously.

For people who are working somewhere inside the current system, that level of change seems unimaginable. When I was still working, that’s how it seemed to me.

For reference, Flower talks about highway safety. If you drove a car or truck in 2010, he points out, you were 10 times more likely to live through each mile you drove than was your father or grandfather 60 years ago. Not because drivers are better — but because a host of tweaks adds up to dramatic improvements in the auto safety system.

Contrary to conventional political wisdom, “The federal health care reform law is a catalyst, an enabler and an accelerator of the change we are going through,” Flower says.

It is not the change itself nor the cause of it, because the change is driven by much larger economic and demographic factors, especially by the crushing cost of health care. If the reform law were to go away, the change would not go away.

Bill Sez: Most people — even most dedicated change-leaders — think in terms of little tweaks or minor adjustments; they want to make the system better without turning it upside-down or inside-out. When Flower declares, “[E]verybody in the business has come to believe that the usual way of doing business is crumbling under them,” I’m not so sure.

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Recession slows health-care cost increase

May 25, 2011 Leave a comment

So there’s good news and bad news about U.S. health-care spending in a new report from the California Health Care Foundation.

First, the good news: health-care spending increased only 4% in 2009, continuing a slower-growth trend that dates back to 2003. The bad news: the slower growth is partly due to the Great Recession, and health care spending still increased to almost 18% of GDP, the highest of all developed nations.

The U.S. continues to spend much more per capita on health care than other countries while achieving mediocre health outcomes. In 2009, per-capita spending exceeded $8,000!

Some economists and Pain Caucus advocates say excess spending is driven by health insurance coverage, that Americans don’t have enough “skin in the game” to be more price-conscious and cost-conscious in their use of health care services. Not so, according to the report: household spending accounts for 28% of all health-care expenditures, more than any other category.

Insurance does pay a large share of the cost of hospital stays and doctor visits, it’s true. But out-of-pocket spending goes heavily towards paying for Rx drugs and medical products, nursing-home care, and dental care, the data shows.

Special interests feast at health-care trough

May 21, 2011 Leave a comment

If all U.S. health-care providers and organizations followed the lead of those who deliver high-quality care at 20% less cost than the average, health-care spending would retreat from 17% of GDP and we would have a $640 billion windfall to apply to other needs.

What stands in the way? Too many individuals and organizations are enriched by the current system and don’t want to change it, according to two prominent physicians who ask “Why Does Cost-Effective Care Diffuse So Slowly?” at the New England Journal of Medicine’s Health Policy and Reform website.

“The answers to this $640 billion question lie in the perceptions and behaviors of the major participants in health care,” say Drs. Victor Fuchs and Arnold Milstein.

For example, health insurance plans don’t want to standardize coverage or administrative processes to save $200 billion a year because that could end up putting downward pressure on profits…and executive pay. Hospital administrators oppose efforts to reduce admissions and occupancy because lower revenues would make it harder to cover fixed costs. Physicians object to any reforms that reduce individual autonomy (to disregard evidence and practice as they please) or alter fee-for-service payment systems that reward specialists for doing more treatments. Legislators are too busy collecting campaign contributions from healthcare interests that benefit from the current arrangements to try to reform the system.

Of course, Fuchs and Milstein agree, the folks with the most to lose are the drug-makers and device and equipment manufacturers

Marketing to consumers and physicians will be much less successful if purchasing and prescribing decisions are made by organizations such as managed-care plans or accountable care organizations that … have the incentive and the ability to evaluate competing products and can negotiate with suppliers for the best value. To preserve the present system, manufacturers of health care products spend heavily on federal lobbying.

Sounds hopeless, doesn’t it? Nevertheless, Fuchs and Milstein call on their professional colleagues to lead the charge:

…physicians are the most influential element in health care. The public’s trust in them makes physicians the only plausible catalyst of policies to accelerate diffusion of cost-effective care. Are U.S. physicians sufficiently visionary, public-minded, and well led to respond to this national fiscal and ethical imperative? It’s a $640 billion question.

Hospitals front for “medical-industrial complex”

May 21, 2011 Leave a comment

Yet more evidence surfaces about how and why the U.S. spends much more per capita on health care than other developed nations yet gets such mediocre results. Like its counterparts in the military-industrial complex, the medical-industrial complex puts profits first and relies on trusted “front men” to make the sale.

First, a new study reveals that, while many hospitals tout robotic surgery on their websites, “Materials provided by hospitals regarding the surgical robot overestimate benefits, largely ignore risks and are strongly influenced by the manufacturer.” More specifically, among the 41% of randomly selected hospital websites that describe robotic surgery,

37% percent presented robotic surgery on their homepage, 73% used manufacturer-provided stock images or text, and 33% linked to a manufacturer website. Statements of clinical superiority were made on 86% of websites, with 32% describing improved cancer control, and 2% described a reference group. No hospital website mentioned risks.

As Fierce Healthcare editor Janice Simmons points out,

[A]ccording to lead researcher Marty Makary, MD, of Johns Hopkins, no randomized, controlled studies have been completed showing patient benefit in robotic surgery. “New doesn’t always mean better,” he says, adding that robotic surgeries take more time, keep patients under anesthesia longer and are more costly.

In an interview with Science Daily, Makary went on to say, “We’re allowing industry to speak on behalf of hospitals and make unsubstantiated claims….Hospitals need to be more conscientious of their role as trusted medical advisers and ensure that information provided on their websites represents the best available evidence.  Otherwise, it’s a violation of the public trust.”

H/t: Gary Schwitzer’s Health News Review Blog.

To screen or not to screen….

May 13, 2011 Leave a comment

Lots of older Americans are undergoing colon cancer tests they don’t need, putting themselves at risk and costing Medicare money it shouldn’t be spending. But when your doctor refers you for screening, don’t you go?

And what happens when screening recommendations change but medical practice doesn’t?

Read more…

Categories: Health care, Media fail

Money makes the (medical) world go ’round

May 7, 2011 Leave a comment

“Nearly half of the $16 million collected by a professional society for heart specialists in 2010 came from makers of drugs, catheters and defibrillators used to control abnormal heart rhythms, according to data on The Heart Rhythm Society’s website, ProPublica and USA Today report.

That’s not all.  “Twelve of 18 directors are paid speakers or consultants for the companies, one holds stock, and the outgoing president disclosed research ties,” the report added.  Of course, the docs and the society leadership deny this is significant. (H/t The Incidental Economist)

Read more…

Shifting Medicare payments from quantity to quality

May 3, 2011 Leave a comment

Medicare is preparing to begin paying hospitals for the quality — not the quantity — of the care they provide. Not surprisingly, hospitals are less than delighted.

According to the rules published last week, in 2012 Medicare will start setting aside 1% of total hospital payments to create a pool from which it would pay bonuses to hospitals that have the best scores — or that show the most improvement — on various measures of quality care. In 2016, the bonus pool would increase to 2% of total hospital payments. (I’m linking to the Kaiser Health News story for its comprehensiveness and overall fairness.)

Ashish Jha, a Harvard School of Public Health professor, told KHN:

“In many ways, it’s a watershed moment for the health care system. It’s a modest amount of money and not something that’s going to radically change the way we pay for hospital care in America. But it’s a really important step toward paying for better care and not just for more care.”

70% of the bonuses will be focused on 12 measures of how well hospitals apply clinical guidelines to patient care: giving anti-clotting drugs to heart attack patients, or giving antibiotics to patients about to undergo surgery. The hospitals seem untroubled by this part of the program; they should be able to manage the treatment process.

But the remaining 30% of the bonus pool will be distributed based on patients’ satisfaction with the care they received: how clean were the rooms, how well did doctors and nurses communicate, how effectively pain was controlled. Hospitals don’t like this part.

Hospital groups had unsuccessfully pushed federal officials to reduce the influence that patient views would have on their payments, arguing that the surveys didn’t always reflect reality and would penalize hospitals in some regions where patients are less forthcoming with praise.

Eventually, Medicare will also use measures that track patient outcomes, not just hospital processes. After all, treatments should achieve positive results, shouldn’t they?

Bill Sez: As a retired health-care worker, I understand…and sympathize with…the discomfort about tying payments to patient satisfaction. It can be really, really difficult to improve satisfaction scores, because you have to get patients to rate you “4” instead of “3” or “5” instead of “4.” Still, there is a substantial knowledge base about health-care quality improvement, so it’s not impossible.

Categories: Health care